9 CUTTING/DISSECTINGThe term knife and scalpel are interchangeable although typically scalpels have a detachable disposable blade and non-disposable handle and knives refers to non-disposable handle and blade such as an amputation knifeScalpels handles sizes include #3, #4, #7, and #9; Beaver blade handle

11 CUTTING/DISSECTING#20, #21, #22, #23, #25 blades fit on a #4 knife handleAny size Beaver blade will fit on a Beaver blade handle#10 blades are the most frequently used blades and should be loaded on a #3 knife handle; do not load #10’s on a #7 knife handle#11, #12, #15 blades are loaded on a #7 knife handle, although a #15 blade is used on a #3 knife handle for small skin incisions

12 CUTTING/DISSECTINGBlades become dull very quickly. 2 or 3 cuts usually dulls the bladeThe blades have to be changed as neededFor safety reasons, if the blade has been changed, the surgeon should be informed that it is a new blade when passing it

13 CUTTING/DISSECTING ScissorsTissue scissors, suture scissors, wire scissors, or bandage scissorsTissue scissors should only be used to cut tissue because others materials will dull them; an exception would be CV surgeons, they use Metz to cut the small suturesWire scissors are used to cut wireBandage and straight mayo scissors can be used on dressings

15 CUTTING/DISSECTINGIn addition to cutting tissue (sharp dissection), scissors are also used to spread and open tissue planes (dull dissection)Curved mayo scissors are used on heavy tissueMetz are used on medium to fine tissueIris, tenotomy, and Potts-smith scissors are used on delicate tissues

18 Grasping/holdingDesigned to manipulate tissue to facilitate dissection or suturing or to reduce and stabilize fractured bone during internal fixationLowman – Turkey clawLane

19 CLAMPING/OCCLUDING Designed to occlude or restrict tissueHave ringed handles with interlocking ratchetsStraight or curved, long or short, pointed or roundVascular clamps have atraumatic serrations that are verticalBulldog clamps are small spring loaded for temporary occlusion – vascularHemostats are used to occlude bleeders until they can be ligated

21 RETRACTING/VIEWING Designed for the exposure of the operative siteMay be hand-held or self-retainingMany sizes and designs; sharp or dull tipsSome retractors are malleableMany hand-held are double-ended with a variation on each end and usually are mostly used two at a time

25 DILATINGUsed to gradually dilate a duct or an orifice to allow introduction of a larger instrument or open a strictureUsed from the smallest to largestMay require lubricationCan be single or double endedCBD, lacrimal duct, tracheal, urethral, cervical

26 SUTURING Used to hold a curved needle– needle holders, needle driversChoosing an appropriately-sized needle holder depends on the size of the needlethe length depends on the depthcan be curved for deep tissueVary by specialtyGeneral, ophthalmic, plastic, GYN, vascular, microscopic

28 SUCTIONING For the removal of blood and bodily fluidsDisposable and non-disposableVary by specialtyAbdominal, ear, neurosurgery, nasal, rectalSome suction devices have the ability to coagulateMany different lengths for trachea, esophageal, larynx – these are not typically used in sterile fashion

29 MICROINSTRUMENTATIONUsed for working under the microscopeSmall and delicateMust be handled with extra care and precision